Prostate Cancer? Yet Another Bogus Justification for Circumcision

As more and more Americans realize they’ve been sold a bill of goods about circumcision, and as fewer parents are willing to allow their sons to be tied down and mutilated for a fee, physicians and others with a financial or psychological interest struggle to find new reasons for promoting the Great American Rip-Off .

This week’s example comes via an article published in the journal Cancer, which describes a “statistical sampling” study leading to the conclusion that circumcision may lead to lower prostate cancer rates. “Circumcision,” the study claims, “can hinder infection and inflammation that may lead to this malignancy.”

I could say a lot about this “study,” but in the interest of brevity and timeliness, I will limit myself to the following:

First, the authors relied on self-reporting for circumcision status, history of sexually transmitted diseases (STDs), and age at first intercourse. Self-reports about disease history and sexual behavior are inherently problematic. Self-reports about circumcision status have been shown repeatedly to have a high error rate of +/- 5 percent, or enough to nullify any statistical significance claimed in the study.

Second, the body of medical literature does not support the claim for a lower rate of STDs in circumcised men—either in the United States or abroad. In response to the new study, Medscape News (login required, free registration) interviewed independent physicians regarding the report in Cancer. Siobhan Sutcliffe, PhD, Assistant Professor of Public Health Sciences at Washington University School of Medicine, noted that results from a self-reporting, case-control study are much less reliable than those from a clinical trial. “It is too early to make recommendations about circumcision for prostate cancer prevention,” she said. “More and different types of studies need to be done before a preventive recommendation can be put forward.” Anthony Y. Smith, MD, Professor and Chief of Urology in the Department of Surgery at the University of New Mexico Cancer Center, also noted that it is “extremely difficult to evaluate the effect of circumcision on a wider geographic scale outside of a controlled clinical trial.” As he mentions, the prevalence of prostate cancer and sexually transmitted infections is similar in the United States, where circumcision is common, to that in Western Europe, where it is not.

Finally, the authors themselves admit that the exact mechanism through which circumcision might prevent prostate cancer remains unknown. Thus, their hypothesis that the foreskin is the cancer-causing culprit requires us to accept that “germs flourishing in the moist environment under the foreskin” somehow make their way into the prostate and cause cancer. Without actual, clinical proof of this, the giddiness regarding one more justification for circumcision is inappropriate—to say the least.

The real lesson here is that current science and news publications set the bar far higher for studies showing the risks and harms of circumcision than they do for lame, unfounded claims touting the “benefits” of removing healthy body parts from babies who are many years away from being sexually active. (And, by the way, whatever happened to condoms, which protect both males and females?) For the promoters of infant circumcision, it appears to be a fact-free, evidence-free environment.

Current estimates of boys leaving the hospital intact range from 33 to 54.5 percent, up from a rate of just 10 percent in the 1960s. It is disheartening that the medical establishment promotes the bogus science, ignores the ethics, and continues to scrape the bottom of the barrel for reasons to keep cutting babies. However, parents are seeing beyond the smoke and mirrors and are getting wise to the Great American Rip-Off.

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I have read that frequent ejaculation is beneficial to the health of the prostate. From years of observation of the change in my own bodily functioning over time (from age 9 to 56), I have drawn some conclusions.

I think prostate cancer is simply the end result of a process of prostatic senescence. I believe it is caused by the static accumulation of hardened prostatic fluid which is not expressed from the gland by muscular contractions that are part of the normal act of ejaculation in increasingly lessening amounts, and over the years, that old, un-moving material causes prostatic enlargement, eventually resulting in malignancy. I offer my observations for the readers’ evaluation.

Over time, beginning in my late 20s, I noticed a change in the quality of my ejaculated fluids: bits of “tapioca-like” material started appearing in the semen. That gelatinous substance was translucent, clear-to-yellowish-white in color, and elongated in shape. The pieces varied in configuration from rice-grain-sized or smaller bits, to longer strands, up to approximately an inch or more in length, with an irregular diameter, but roughly 1/16″ wide. It occurred to me that the stuff was prostatic fluid that had congealed inside the prostate gland, taking the form of the convoluted passageways of the prostatic vesicles.

As I progressed through my 30s, the castings increased in quantity, density, and size. The pieces became large enough that I could feel them pass through the vas deferens during ejaculation. Eventually, however, the process reached the point where they were no longer consistently ejected. By my mid-40s, I started to experience all the typical middle-aged man’s complaints of increased need and frequency of urination, diminished bladder capacity, occasional prostate discomfort, and erectile dysfunction, along with loss of strength of ejaculation. It got to where I was not blowing out the congealed prostatic fluid much any more. Now in my mid-50s, I only occasionally see any of the material in my semen at all, even after an especially vigorous ejaculation (considering my current capability, that is).

Therefore, within the context of this article, I would say that anything that reduces penile sensitivity, thus affecting the strength of ejaculation, resulting in lessening of muscular contractions that force material from the prostate gland, can be detrimental to its health, and may contribute to the eventual onset of prostate cancer. Whether climax is achieved through sexual intercourse or masturbation, it makes little, if any difference.

The most elementary of deductive reasoning would lead one to the conclusion that removal of the foreskin, even partially, decreases the number of nerve endings available for production of penile sensation, and also exposes the most sensitive portion of the skin and glans of the penis to non-sexual abrasive de-sensitization, thus further compounding the detrimental effect of circumcision. The only possible health benefit, a slight increase in the ease of hygenic cleaning of the protected skin, is so minor, it is laughable to mention it, in light of the non-surgical alternative: rolling the skin down and washing the penis.

Circumcision is an idiotic practice that benefits no one but the doctors who perform it for additional personal revenue. It should be no more a part of medical practice than tattooing or body piercing, which also are barbaric, even atavistic forms of mutilation of the largest organ of the human body: the skin. So, doctors, I say to you: CUT IT OUT, NOT OFF!

Two of the medical journals that my husband receives in the mail just reported this story, and it made me really mad. They added at the conclusion of one of the articles that the researchers “reported no biases” in their investigation of this topic. How can people who live in a culture that still promotes amputation of healthy body parts from unconsenting infants claim to have no biases? Are the “researchers” circumcised themselves? Then that is a bias too. It’s ridiculous.

Because the idea of “penile sensitivity” seems to come up a lot in these blogs, I have a question. Could circumcision have developed, in part, to thwart masturbation? Just a fugitive thought that wafted across my mind….

Circumcision does make masturbation more difficult and less pleasurable for many men. There are studies based on men circumcised as adults that show this. After restoring my foreskin, I can say that masturbation is much more pleasurable with my restored foreskin than it was before I started restoring.

I like your soundbite: The Great American Rip-off. It reflects the financial abuse of the parents, but at the same time the brutality done to squealing infants who have their skin literally torn from their flesh…

You’re right that the circ-hawks are getting too much of a hearing in the scientific and general media. But touting poor quality studies such as this one does seem to show a degree of desperation.

I agree that they are more desperate. They have been publishing their tripe in the “pay-to-play” journals often overstating their case. If it was a good idea, simply stating it would be convincing. The embellishments make them look desperate. More and more people are realizing the circumcision solution does not pass the smell test.

Even if this article was accurate, as a doctor in New Zealand says “We could prevent 50 per cent of testicular tumours, which are far more common, by removing one testicle from each male”. This would make more sense than circumcising to reduce the risk of prostate cancer.

Since more testicular tumor occur on the left rather than the right side, it would be more effective to remove the left testicle. The program could use Lance Armstrong as the example what can be accomplished with only only one testicle.

If they wanted to get some useful insight into risk factors for prostate cancer, they would have taken their blood and assessed levels of androgens, estrogens and estrogens analogs such as BPA, as well as Vitamin D3 and Vitamin K2.

Obviously legitimate science was not the objective here. Is there any info on the source of the funding for this misadventure in junk science?

The biggest flaw I see with this absurd study is that prostate cancer is a relatively occult disease to diagnose. PSA levels are often difficult to interpret, often there are no clinical symptoms and the prostate exam may be entirely normal. Ultrasound guided transrectal biopsies are the best method to confirm prostate cancer, but they can be inconclusive as well. How did the researchers ensure that the cancer free group did not have occult prostate cancer? Did they perform ultrasound guided biopsies on all 1600 cancer free men? Many of the cancer free group likely have prostate cancer and just haven’t been diagnosed yet, as prostate cancer is a very common disease. This would destroy the statistical value of the study. This study is a disgrace to medicine and the scientific method in general.

It is not so disturbing that someone collected this data and tried to get it published. What is disturbing is that someone paid to have such a poorly designed performed. What a waste of money. What is even more disturbing is that an editor of a well-regarded would publish such tripe and send around press releases before it was published. If the same study with the same poor design had found that circumcised men were at greater risk for prostate cancer, the article would never have been sent out for review, let alone published.

Given the reliance on self-report of circumcision status, it is quite possible that if the data were collected properly that the data could have shown the circumcised men were more likely to get prostate cancer. If 3.9% of the men in the control group who said they were circumcised were actually intact, then the study would have found that circumcised men were more likely to get prostate cancer (the difference would not be statistically significant). This is certainly possible.

It has to do with editorial standards, which go out the window when it comes to promoting infant male circumcision.

I don’t buy the 15% risk change, certainly not based on the garble I have read about this. Thanks Petit Poulet for helping me understand what it is they think they are saying.

Even if this was a real risk issue, I would think most men would want to have all of their penis. The starting point for this discussion is a bit wacky, trying to find a reason to continue to remove penis parts of babies. The first thoughts should always be that the human gets to keep the body parts and then deal with potential disease. If no one was cutting babies, no one would ever consider starting this practice for any of this risk reduction talk.

The authors relied on self-report for circumcision status. They should have known that two studies have shown that 30% of men are unsure or mistaken about whether they are circumcised or intact! Thirty percent! That skews their result so badly that their study is worthless. As they say in science, “junk in, junk out.’

If the data for this study were obtained by “convenience sampling,” as is often the case, the study is largely worthless. The gold standard in such studies is stratified random sampling. If the data collection did not involved a clinical examination and a blood test for the PSA antigen, the study is again largely worthless.

For American men over 30 or 40, the circ rate slowly declines with age. Before WWII, most American men born into farm and working class families were not circumcised at birth. Another fact is that until Medicaid started paying for RIC in the late 1960s, those born into impoverished and uneducated families were less likely to be circumcised. Meanwhile, prostate cancer is mainly a disease of older men. It is also more common among impoverished and uneducated men, especially the African American underclass. And there lies the rub: the strata of American society where prostate cancer is most prevalent are also strata where circumcision is less common. The findings of the study are spurious. X appears correlated with Y because both X and Y are correlated with the same things, namely age and socioeconomic status.

When does academic dishonesty become fraud? This might be an example. The authors reported a 15% decreased risk in prostate cancer. Where did that number come from? Apparently the numbers appeared magically from their gastrointestinal tract.

Let’s look at their numbers. 71.5% of the 1645 men who did not have penile cancer reported being circumcised. That is 1176 circumcised men and 469 intact men in the control group. The problem is that when you ask men whether they are circumcised about 5% to 15% of the men who say they are circumcised, are not circumcised. In this group that would be between 59 and 176 who were intact, but called themselves circumcised.

68.8% of 1754 men with prostate cancer (1207) identified themselves as circumcised, so 547 were intact. Again the 5% to 15% of misidentification as circumcised would be between 60 and 181 men,

My calculator tells me the difference between 71.5% and 68.8% is only 2.7%, not 15%. Maybe they mean relative risk, which should only be using in prospective studies which this wasn’t. This would be the ratio of the two percentages (.688/.715) or 0.96, which is a 4% reduction and certainly not 15%. Maybe they compared the ratio of intact percentages (.285/.312) or 0.91 or a 9% reduction and certainly not 15%.

That leaves odds ratio ((1207*469)/(1176*547)) which is 0.88 (95%CI=0.76-1.02) or a 12% reduction that is not statistically significant. If you calculate the inverse it is a 14% increase. Neither of these are a 15% difference. So where did the 15% come from???

As the misclassification percentage increases the difference between the two groups decreases. They also fail to incorporate the uncertainty of accurately identifying the circumcision status of the men involved in the study in estimating the uncertainty of their estimate of the association between circumcision status and prostate cancer. The possible misclassification could account for more than the difference the study reported.

The study authors speculate that the difference in prostate cancer rates based on circumcision status is because circumcised men get fewer sexually transmitted infections. The study authors should not rely on pro-circumcision propaganda, but rather should look to the medical literature for evidence-based information. If they had bothered to look at the medical literature the would have found that the opposite is true, especially for infections that involve the urethra.

If they had bothered to look at the medical literature, they would have found that Hispanics in the United States have lower age-adjusted rates of prostate cancer than Caucasians, Europe has lower rates of prostate-cancer than the United States, and as the circumcision rates have increased in the United States so have the prostate cancer rates.

A 2.7% difference in a study where the accuracy in measuring the independent variable of interest could be off by as much as 15% suggests that this study did not receive proper peer-review or the editors published it as part of their personal agenda.

From what I’ve read and been told almost all men will get prostate cancer, a disease of age. Also men are warned about testosterone treatments as it can affect the chance of getting prostate cancer. More voodoo science for those who hate the intact penis.

The claim that circumcision prevents AIDS is another myth. If that were true, why are so many of my circumcised friends dead and I’m still alive?

I participated in the study of penile sensitivity several years ago and what I already knew was proven, the intact male is much more senistive to touch.

Thanks for a fact-based response to an article that should never have passed peer review.

You write: “It is disheartening that the medical establishment promotes the bogus science, ignores the ethics, and continues to scrape the bottom of the barrel for reasons to keep cutting babies.”

It is quite a paradox that, in the Netherlands, Sweden, Norway, and other European countries, the situation is to the contrary. In northern Europe, where I live, the medical establishment is protesting with a mighty voice against non-therapeutic circumcision. Gunnar Göthberg, chairman of the Swedish Pediatric Surgeons Association (Svensk barnkirurgisk förening), compares the procedure to female genital mutilation. Trond Markestad, head of the ethics committee of the Norwegian Medical Association (Den norske legeforening), argues that circumcision should be phased out. In the Netherlands, the Royal Dutch Medical Association (KNMG) has stated officially that circumcision violates a child’s integrity and should be banned by the government.

Rolf Kirschner, a physician and former head of the small Jewish community in Norway, is almost a lonely voice among Scandinavian physicians in accusing the medical associations of anti-Semitism. This accusation is too grave to be lightly accepted.

This difference between American and European physicians is interesting in its own right, and from several perspectives. Does the pro-circumcision lobby depend on the commercial demand for human tissue? Or is the cultural difference due to the fact that, in northern Europe, the number of Jewish physicians is not nearly as high as in the U.S.?

I strongly agree with your statements.
i just want to correct what seems to be an accidental error.
Didn’t you mean to say that in the 1960’s, only 10% of American boy babies were leaving the hospital intact?
When you said “down from 90%”, shouldn’t that have read “UP from only 10%”?

To be valid, this study needs to compare prostate cancer rates between circumcised men and uncircumcised men. One needs to look at prostate cancer rates in Europe, Latin America, and Asia where most men are not circumcised. One then needs to compare these rates with those of the United States where about 65-70% adult men are circumcised. In addition, community rates among the Chinese, for example, need to be compared with African-Americans and Americans of European descent. The study appears to be incomplete.

That would be a ‘real-world’ study which the pro-circumcision lobbyists would never want to look at. No real-world study, for prostate cancer or any of the other bogus claim, will ever show a benefit for circumcision.